From the Research
Managing sexually inappropriate and aggressive behavior in nursing home patients requires a comprehensive approach that prioritizes assessment of underlying causes, behavioral interventions, and staff training to ensure patient dignity and safety for all residents and staff. This approach should begin with ruling out medical conditions like urinary tract infections, medication side effects, pain, or neurological disorders that may contribute to these behaviors 1. For dementia patients, behavioral interventions should be the first-line approach, including redirection, distraction, maintaining consistent routines, and providing appropriate outlets for physical and social needs. Environmental modifications such as private spaces for intimacy needs, removing triggering stimuli, and ensuring proper clothing can help reduce incidents.
Some key considerations in managing these behaviors include:
- Assessing the capacity to consent to sexual activity of residents with dementing illness and re-evaluating capacity as the diseases progress 1
- Recognizing that resident-to-resident aggression is a ubiquitous phenomenon in nursing home settings, with important consequences for affected individuals and facilities 2
- Understanding that staff perceptions and responses to residents' sexual behavior are influenced by their own level of comfort related to sexuality issues and the ethos within the organization where they work 3
- Implementing staff training on respectful communication, recognition of triggers, and appropriate responses to address these behaviors 4, 5
If behavioral approaches are insufficient, medication may be considered, though cautiously. Low-dose antipsychotics like risperidone or quetiapine may be used for short periods, while SSRIs like sertraline can help with impulsivity. Antiandrogens such as medroxyprogesterone acetate may be considered in severe cases under specialist guidance. Regular reassessment of interventions and documentation of behaviors and responses helps refine the approach. This multifaceted strategy respects patient dignity while ensuring safety for all residents and staff, as supported by the most recent and highest quality study on the topic 1.